How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners

Abstract

ObjectivesRecent years have witnessed a progressive increase in defensive medicine (DM) in several Western welfare countries. In Danish primary and secondary care, documentation on the extent of DM is lacking. Before investigating the extent of DM, we wanted to explore how the phenomenon is understood and experienced in the context of general practice in Denmark. The objective of the study was to describe the phenomenon of DM as understood and experienced by Danish general practitioners (GPs).DesignA qualitative methodology was employed and data were generated through six focus group interviews with three to eight GPs per group (n=28) recruited from the Region of Southern Denmark. Data were analysed using a thematic content analysis inspired by a hermeneutic-phenomenological focus on understanding and meaning.ResultsDM is understood as unnecessary and meaningless medical actions, carried out mainly because of external demands that run counter to the GP’s professionalism. Several sources of pressure to act defensively were identified by the GPs: the system’s pressure to meet external regulations, demands from consumerist patients and a culture among GPs and peers of infallibility and zero-risk tolerance.ConclusionsGPs understand DM as unnecessary and meaningless actions driven by external demands instead of a focus on the patient’s problem. GPs consider defensive actions to be carried out as a result of succumbing to various sources of pressure deriving from the system, the patients, the GPs themselves and peers.

How do doctors in the Netherlands perceive the impact of disciplinary procedures and disclosure of disciplinary measures on their professional practice, health and career opportunities? A questionnaire among medical doctors who received a disciplinary measure

“…Studies show that procedures related to medicine and law, such as complaints or disciplinary processes, often have a major impact on health, personal life and professional functioning,10–14 leading to concerns about the quality of healthcare these professionals provide. A second concern is the phenomenon of ‘defensive medicine’,15–17 referring to the practice of performing additional and unnecessary diagnostic tests or the avoidance of high-risk medical treatments for patients in an effort to avoid complaints or claims. Whether fears of disciplinary consequences are justified or not, if professionals display defensive practices these can raise healthcare costs and may subject patients to unnecessary tests and processes 12 18.…”

How defensive medicine is defined and understood in European medical literature: protocol for a systematic review

“…Furthermore, it has been associated with overtreatment, overprescription and overdiagnosing of patients and decreased trust in the physician–patient relationship, leading patients to mistrust physicians’ motivations and physicians to regard patients as potential plaintiffs 7 9–12. Moreover, physicians report patient disrespect for their professionalism, personal frustration and inequality in healthcare as possible consequences of DM 13 14…”

“…In several European countries malpractice litigation is reported to happen less frequently than in the USA, for example in The Netherlands,2 18 Denmark,13 Switzerland19 and the UK 20. In these countries, the medicolegal system does not hold physicians financially liable for malpractice or other treatment related adverse events.…”

“…The patients are instead compensated by the government (known as a no-fault system) 21–23. Nevertheless, DM seems also to be prevalent in Europe, for example Denmark,13 the UK,24 Italy,12 Belgium,25 The Netherlands,2 Germany26 and Switzerland 20. Furthermore, a substantial part of research on DM seems to originate from Europe.…”

Defensive medicine: It is time to finally slow down an epidemic

“…Also, the media should realize the extremely damaging nature of reporting presumed medical errors and subjecting physicians to public trials through newspapers, radios, television or websites before they are eventually judged in court[ 32 ]. We exhort colleagues not to succumb to pressure deriving from the system, the patients, and their peers[ 33 ], and we urge healthcare administrators, policymakers, patients’ organizations and journalists to cooperate and make healthcare systems better and safer.…”